32% of older women who survived certain cancers report lower extremity lymphedema

Nearly one-third of older women who survived colorectal, endometrial or ovarian cancer reported lower extremity lymphedema, according to data published in JAMA Network Open.

Researchers also found that lower extremity lymphedema (LEL) was associated with decreased physical functioning (PF) and greater odds of needing help with everyday activities.

“I have had a long-standing interest in lymphedema due to being diagnosed with it after breast cancer treatment over 25 years ago,” Electra D. Paskett, PhD, professor and Marion N. Rowley Chair in Cancer Research at The Ohio State University, told Healio. “Since then, I started a research path in this area.”

LEL can affect cancer survivors’ ability to walk, lift heavy objects or stand for long periods, which decreases quality of life and increases need for supportive care, Paskett and colleagues wrote in the study.

“However, the association of LEL with decreased physical activity and mobility to perform [activities of daily living (ADLs)] among older survivors of cancer is understudied. Because of age-associated PF decline, it is possible that older survivors of cancer with LEL may experience additional challenges in PF and interference with ADLs compared with those without LEL,” the researchers wrote.

Using data from the Women’s Health Initiative (WHI) and the WHI Life and Longevity after Cancer (LILAC) Study, the researchers identified 900 postmenopausal women (mean age, 78.5 years; 91.9% white; mean time since cancer diagnosis, 8.75 years) who were diagnosed with endometrial, colorectal or ovarian cancer, and who had completed 1-year follow-up questionnaires on LEL symptoms, PF and ADL as of September 2017.

LEL was reported by 292 women (32.4%), with the highest proportion among the 104 women who survived ovarian cancer (n = 38; 36.5%). Women who were older, widowed, publicly insured, had higher BMI and had radiation or chemotherapy more commonly reported LEL.

Decreased PF with LEL

PF questionnaire scores indicated that women who did not report LEL — who scored higher than those who reported LEL — had better PF. In the adjusted analysis comparing women who did and did not report LEL, the mean difference was greatest among women who survived colorectal cancer (21.8 points).

Stratifying by age group, Paskett and colleagues found that PF scores differed more between women who did and did not report LEL in the 80 years and older group (19.4 points) compared with women aged 65 to 79 years (14.9 points).

Increased need for help with ADLs

Women who reported LEL were more likely to need help with ADLs compared with women who did not report LEL (adjusted OR = 2.45; 95% CI, 1.64-3.67). Stratified by age group, women aged 80 years or older had greater odds of needing help with ADLs (aOR = 3.39; 95% CI, 1.99-5.79) compared with women aged 65 to 79 years (aOR = 2.03; 95% CI, 1.13-3.61).

“Patients with these cancers should receive surveillance for the development of LEL and then be referred for treatment early to prevent progression and impact on physical functioning, which can ultimately impact mortality,” Paskett said.

The researchers warned that since they used self-reported data only, their findings may be skewed by recall and survivor bias. Other study limitations included demographic homogeneity of the study population and no access to surgical information.

Moving forward, Paskett said research is needed on the “prevalence of LEL in men and younger survivors of colorectal cancer and interventions to prevent or reduce the impact in all populations.”